Kicking Candida

Some see it as a fad diagnosis. Others see it as the culprit behind a vast array of common, sometimes debilitating, health woes. Just about everyone wishes it would go away. Here’s what you need to know about successfully tackling the yeast beast.

Sara Jasper*, an aspiring Twin Cities painter, had always thought of herself as sickly. When she was a child, month-long bouts of bronchitis kept her in bed and out of school. Her frequent nosebleeds were sometimes so severe that she woke up in a pool of blood that had soaked her mattress and spilled over the sides of her bed and on to the floor. By the time Sara was 20, depression and an overwhelming fatigue were a part of her identity. Feeling sick was, she figured, her lot in life.

Then the fevers started. Once a month, Sara’s temperature would climb to as high as 105 degrees, leaving Sara so physically depleted that she routinely slept 14 to 16 hours a day. A student at the University of Wisconsin at Madison, Sara was missing classes and growing increasingly anxious about her life. Her fevers concerned the school’s student health service but didn’t provide much insight into the root of the problem. Some doctors suspected a virus, some prescribed antibiotics, others implied a psychosomatic illness. When one doctor diagnosed her with a sexually transmitted disease, Sara broke down sobbing. “It was impossible. I was a virgin and had never been sexually active,” she explains. “I was so frustrated and exhausted by all the misdiagnoses and misinformation that I called my mother and told her I couldn’t handle it anymore.”

A healthcare advocate, Sara’s mother had more resources available to her than the average anxious parent. She suggested that Sara move back to the Twin Cities to work with a preventative healthcare doctor, an MD who’d left a prior practice in order to spend more time with his patients. Sara’s new doctor gave her a two-hour assessment, asked her to fill out a booklet’s worth of personal health and history questions and to provide a blood and stool sample. One month later, the tests confirmed her doctor’s hunch: Sara appeared to be suffering from a serious overgrowth of Candida albicans, a yeast-like fungus that exists naturally inside every human body. Sara’s doctor explained that when a body is healthy, the immune system regulates Candida growth. But if our immune system is compromised, Candida can multiply unchecked, triggering a vicious cycle of symptoms and serious health problems.

At first, Sara didn’t exactly understand what her doctor was describing, but a trip to the local bookstore told her that she wasn’t alone. The titles alone were overwhelming: The Yeast Connection, The Yeast Syndrome, Candida-Related Complex, Chronic Candidiasis, The Candida-Yeast Syndrome. Each book referred to Sara’s condition by a different term and also suggested divergent, and often contradictory, approaches to treating it. The only thing the experts agreed on was that Candida-related illnesses are not a figment of a person’s imagination, but rather a silent epidemic that is wreaking havoc with a startling percentage of the American population.

Mystery Malady

In 1978 George Kroker was an allergy fellow at a Chicago area clinic. A conventionally trained MD, Dr. Kroker believed the best way to treat patients was to use tried and tested protocols. Then he had a patient with a complex set of allergy symptoms who wasn’t, despite his best efforts, responding to conventional treatments. When the patient left his clinic to pursue other forms of treatment, Dr. Kroker assumed that he’d never hear from her again. A few months later, she contacted Dr. Kroker to report that a Birmingham, Ala., allergist named C. Orian Truss had successfully treated her allergies by controlling the level of Candida in her body.

Dr. Kroker was delighted to hear his former patient’s positive news and was curious enough about her treatment that he looked more closely into Dr. Truss’s theories. When another patient didn’t respond to conventional practices, he gave her Nystatin, an over-the-counter, antifungal medication. Her symptoms improved, and Dr. Kroker decided it was time to seriously consider the role Candida overgrowth was playing in his patients’ health.

In 1980, Dr. Truss, Dr. Kroker and a handful of other doctors met in Dallas to compare notes about the increasing number of patients they treated who were experiencing a seemingly incurable combination of headaches, fatigue, depression, irritability, digestive disorders, respiratory disorders, skin rashes, vaginal infections and sensitivity to chemical odors and additives. “We all agreed that we were seeing the same kind of patients,” remembers Dr. Kroker, now an allergy specialist at Allergy Associates in La Crosse, Wis. “And that all of them responded to antifungal medicine.” They left the meeting convinced that an overgrowth of Candida albicans was the key to their patients’ health problems.

One doctor at the meeting was William G. Crook, who surveyed his colleagues about their findings and used the results to write The Yeast Connection: A Medical Breakthrough. The book was a bestseller and Crook, now deceased, became a national spokesman for the controversial new disease.

Yeasts and You

Yeasts are a part of our everyday lives. More than 300 types exist on the surface of healthy human skin. Inside our bodies, as many as 500 varieties of viral, bacterial and fungal microorganisms, including Candida, exist. Candida lives primarily in the mucous membranes of the mouth, intestinal tract, digestive tract and vagina. While vaginal Candidiasis, oral thrush and yeast overgrowths such as diaper rash and jock itch are common medical conditions that all physicians agree should be treated, the notion that Candida yeasts can also proliferate within the intestines and elsewhere in the body remains more controversial in conventional medical circles.

In The Yeast Connection, Dr. Crook insisted that an overgrowth of Candida is at the root of many childhood ear infections, attention and hyperactivity disorders, and even autism.

Mary Shomon, a Washington, D.C.-based patient advocate and author of Living Well With Hypothyroidism: What Your Doctor Doesn’t Tell You That You Need to Know (HarperResource), suggests that Candida proliferation may be a factor in many thyroid-related and autoimmune disorders. “What I’ve found is that Candida weakens the immune system so that it isn’t able to fight off pathogens,” she says.

In her research, Shomon has interviewed many doctors who report that when a person suffering from hypothyroidism or fibromyalgia is treated for Candida, it is not unusual for many, if not all, of their symptoms to lessen or disappear. But not everyone is eager to acknowledge such connections. Much of mainstream medicine dismisses Candida as a fad diagnosis – a one-size-fits-all solution to a wildly divergent set of health complaints.

“There is no scientific data to support that Candida is related to these symptoms,” says Dr. Malcolm Blumenthal, a professor of medicine and the director of the Asthma and Allergy Program at the University of Minnesota in Minneapolis. “Everyone also breathes oxygen. But when people get sick, no one says that it’s due to the oxygen.” Dr. Kroker says he is used to such skepticism. “Most doctors won’t treat a problem that lacks a proven method of diagnosis,” he says. “And the truth is that we aren’t entirely certain that Candida is the crux of these health problems, even though we do know that they are yeast-related.”

Some critics cite admissions like Kroker’s as confirmation that a Candida diagnosis is the ultimate in fuzzy science. But he rejects this notion. “No one is going to tell a breast cancer patient that they aren’t going to treat them just because they don’t understand precisely how they got the disease. The way I see it, any physician faced with a condition for which there is no definitive diagnosis has two choices: You can ignore the problem, or, if there is a safe and promising trial cure, you can give that a try.”

Common Complaints

Some experts estimate that as much as 50 to 80 percent of the American population is suffering from a mild to severe Candida-related illness. Christine Winderlin, who (with the late Keith Sehnert, MD) coauthored Candida-Related Complex: What Your Doctor Might Be Missing, estimates that 80 to 90 percent of Candida-related-illness sufferers are women of childbearing age. People with AIDS and cancer are particularly susceptible because their immune systems are weakened and can be easily taken over by opportunistic organisms.

How does such a common organism make so many of us ill? According to Dr. Michael McNett, the owner and medical director of Paragon Clinic, a Chicago-area clinic that specializes in treating fibromyalgia, when Candida multiplies to high levels it also enters the bloodstream. “Once that happens, your immune system has to develop an immunity to yeast in order to wipe it out of the bloodstream,” he says. “But once the immune system has been sensitized to yeast, it can tell when it is in the gut and will attack it in the intestines. When that happens, Candida releases chemicals that are absorbed by the body and make you sick.”

According to physicians who treat Candida-related illnesses, the overuse of broad-spectrum antibiotics and steroid drugs in both medicine and agriculture is at least partially to blame for the modern proliferation of Candida. Antibiotics are powerless against yeasts but wipe out the “friendly” bacteria that tend to keep yeast growth in check. Because antibiotics disrupt the body’s delicate balance of microorganisms, they also pave the way for opportunistic Candida and other yeasts to multiply and circulate toxins throughout your body.

Oral contraceptives and pregnancy have also been identified as having a probable role in promoting Candida overgrowth as a result of hormonal changes. Many doctors also suspect overuse of nonsteroidal anti-inflammatories (NSAIDs) such as aspirin and ibuprofen can contribute to creating a Candida-friendly environment. Other Candida specialists blame Candida overgrowth on diet – specifically, our society’s addiction to sugar and other simple carbohydrates at the expense of a diet rich in fiber and complex carbohydrates. Simple sugars are rapidly metabolized by yeasts; they also inhibit the growth of friendly bacteria, which further compromises the immune system. According to Crook, stress, diabetes and allergies can all increase a person’s susceptibility to a Candida-related illness.

Dr. Kroker says that people with mold allergies frequently have a cross-sensitivity to Candida. Exposure to environmental toxins in food, air and water may also lower immunity and promote susceptibility to yeasts in general.

Difficult Diagnosis

Diagnosing a Candida-related illness can be tricky. “Because we all have a certain amount of it in our bodies, you really can’t culture for it,” says Kroker. The fact that different doctors use different testing methods only inflames conventional physicians’ skepticism about Candida overgrowth as a bona fide health issue. Some doctors rely on blood tests while others prefer stool tests to measure antibodies to the Candida antigen. Still others, Dr. Kroker included, believe that a detailed medical history is the best way to determine if Candida overgrowth is a factor in a patient’s poor health. “You look for susceptibility factors and load factors,” he says. “If a person has a family history of allergies and they are taking antibiotics, I want to look further.”

Almost every Candida book includes a health questionnaire to help you determine whether or not a yeast overgrowth may be contributing to your health complaints. While these questionnaires are helpful, they are not conclusive. A high number of “yes” answers doesn’t mean you should immediately start treating yourself for Candida overgrowth. Rather it’s an indication to seek out a healthcare practitioner who will consider yeast overgrowth as a possible factor in your health complaints.

In general, alternative health practitioners are more willing than conventionally trained physicians to consider that Candida is a serious health concern. In anticipation of most MDs’ skepticism, The Yeast Connection Web site (www.yeastconnection.com) provides a downloadable physician’s packet that includes a letter for your doctor, a list of tests, a medical history form and a daily symptom chart. It also hosts an online discussion board as well as facilitating support groups where you can exchange information and ask other Candida sufferers in your area for referrals.

Treatment

Treating a Candida-related illness is almost as controversial as the disease itself, since every expert has a different opinion about treatment. Most specialists agree that a phased approach is required in order to: a) starve and kill the yeast, b) promote the growth of good bacteria and c) maintain an anti-Candida lifestyle. But that’s where the agreement ends.

For every doctor who advocates a diet free of all sugars and starches, you’ll find an equal number who believe that it’s okay to eat potatoes or rice or some fruits. Elson Haas, MD, author of Staying Healthy With Nutrition, is among the many who stress healthy eating but who also use herbal supplements (see sidebar near bottom of page) and prescription-strength antifungal medications such as Nizoral and Fluconazole to get yeast out of the body.

Prescription antifungals act quickly and effectively, but like most prescription drugs, they can also cause side effects. Because they do nothing to alter the underlying dietary and lifestyle conditions that encourage yeast overgrowth, they also provide no protection against recurrence. One small study published in the 1995 Townsend Letter for Doctors and Patients (see www.wholeapproach.com/comp.html) showed that Monistat, Nystatin and Fluconazole performed less well than natural supplements such as acidophilus and garlic in sustaining long-term improvement.

Because post-medication recurrence is common, most Candida experts suggest that antifungal medications and supplements be viewed as only one component of a more holistic, longer-term strategy that includes reducing or temporarily eliminating certain foods and substances and then following a rotation or maintenance plan once you begin reintroducing Candida-fueling foods into your diet.

Dr. Crook’s The Yeast Connection is the most hardcore. In addition to suggesting that you rid your home of all chemical pollutants (including cigarette smoke, perfumes and contaminants found in tap water) and supplement your diet with essential fatty acids, The Yeast Connection advocates a multistage diet. Crook’s first step is to eliminate sugar, corn syrup, white bread and other white flour products, soda pop, most ready-to-eat cereals, and all sweet and salty snack foods, “because foods containing these nutritionally deficient simple carbohydrates encourage yeast overgrowth and promote poor health.”

For the first three weeks of the diet, The Yeast Connection also nixes processed and prepared junk foods containing hydrogenated or partially hydrogenated fats, as well as those spiked with additives and food coloring. Also on the “Do Not Eat” list: all fruits, alcohol, condiments, sauces and vinegar-containing foods, malt products, processed and smoked meats, mushrooms, morels, truffles, dried fruits, candy, coffee, tea, diet sodas, and breads, pastries and other bakery goods made with yeast. Leftovers, which are susceptible to growing molds, are also forbidden.

After you’ve avoided yeast-containing foods for 10 days, The Yeast Connection advises that you determine whether or not you are sensitive to yeast by eating a tablet of brewer’s yeast. If you develop no symptoms, it suggests trying a piece of cheese with a high-mold content, such as blue cheese or Gorgonzola. If consuming these yeasty foods triggers symptoms, then you should further avoid them for several weeks. Once you pass the “yeast challenge,” The Yeast Connection gives you the green light to add cheeses, mushrooms and other yeast-containing food to your diet on a rotated basis so you can monitor which foods trigger your symptoms.

After the first three weeks, you are free to experiment and add back all fresh vegetables, all fresh fruits and whole grains in moderation. (If you’re wondering how long it will take to return to your regular breakfast donut, you’ll be saddened to learn that people who are prone to yeast overgrowth are advised to permanently give up table sugar, or at least treat it as a very special indulgence.)

Dr. Crook’s The Yeast Connection Handbook stresses that every person is an individual and that there is no single magic solution that will cure everyone. Some people will find that they can tolerate cheese but not peanut butter. Others will react well to fruit but not breads.

Following any serious anti-Candida diet is hard work. It can also trigger intense cravings, especially when the yeasts start to die and decompose, releasing still more toxins into your body. Known as the “die-off effect” or “Herxheimer reaction,” this nasty flare-up can cause withdrawal-like cravings for sugars and carbs, a brief return of original symptoms, or a variety of immune-related maladies.

The good news: The effect is only temporary and an indication that your treatment is doing its job! Die-off reactions can last from a few days to a few weeks, but most clear up in less than a week. Many experts suggest that drinking lots of pure water and increasing your intake of fiber-rich foods can help speed along the clearing and detoxification process.

When embarking on the multistage diet, it’s important to take the long view. Remember that the majority of people who follow The Yeast Connection regimen are able to follow a less-rigid diet as their health improves, particularly when they incorporate exercise and stress reduction into their lives. Yeastconnection.com and other Candida-support Web sites offer a variety of strategies to help get you through the difficult first weeks of an anti-Candida regimen.

Most experts suggest that people on the diet should take probiotics, such as acidophilus, which help recolonize and promote the growth of healthy bacteria. These healthy bacteria produce antimicrobial enzymes and natural antibiotics that retard the growth of Candida.

Finally, curbing a Candida-related illness often requires a commitment to a more balanced and sustainable lifestyle. Beyond adopting a healthier diet, you may also need to avoid exposure to immune-stressors of all kinds, including household and other environmental chemicals, toxins and molds.

So is all this work worth it? Sara Jasper hasn’t the smallest doubt. Five years after her debilitating bout with Candida, she still leans away from sugar and wheat, but she no longer adheres to an overly restricted diet. Along with daily walks along the Mississippi River, Sara practices qi gong to manage her stress and says she feels healthier than she has in her entire life.

“Sticking with the Candida treatment was tough at first, but it paid off quickly, and on so many levels,” she says. “It helped me reclaim my physical health, but more importantly, it also helped me redefine myself as a healthy person – for the first time in my adult life, really. Getting free of all that physical misery changed my entire outlook, not just about health, but also my choices, my freedoms and my opportunities for happiness.”

Got Yeast?

Many Candida specialists depend on questionnaires such as the one below to help patients identify symptoms that are potentially yeast-related. The following questionnaire is excerpted from The Yeast Connection by William G. Crook, MD. A more detailed questionnaire can be found at www.yeastconnection.com.

· Have you taken repeated "rounds" of antibiotic drugs?
· Have you been troubled by premenstrual tension, abdominal pain, menstrual problems, vaginitis, prostatitis, or loss of sexual interest?
· Does exposure to tobacco, perfume and other chemical odors provoke moderate to severe symptoms?
· Do you crave sugar, breads or alcoholic beverages?
· Are you bothered by recurrent digestive symptoms?
· Are you bothered by fatigue, depression, poor memory or "nerves"?
· Are you bothered by hives, psoriasis, or other chronic skin rashes?
· Have you ever taken birth control pills?
· Are you bothered by headaches, muscle and joint pains or incoordination?
· Do you feel bad all over, yet the cause hasn't been found?

Scoring:
If you have three or four "yes" answers, yeasts possibly play a role in causing your symptoms.

If you have five or six "yes" answers, yeasts probably play a role in causing your symptoms.

If you have seven or more "yes" answers, your symptoms are almost certainly yeast-connected.

Supplements

These are just some of the supplements used by naturopathic physicians to inhibit or treat Candida and other fungus-related symptoms, most often in conjunction with dietary changes and/or prescription medications. As with all supplements and medications, check with your physician or healthcare provider to avoid undesirable sensitivities or drug interactions.

James, I would start with the books, get some anti-candida supplemetns, and start the anti-yeast diet. A doctor will tell you the same thing, unless you want to go the nystatin/diflucan route. I would go with the natural stuff first as it is equally effective for most. Diet is the biggest part of all this.

Hi Elizabeth, good article thanks! This link is really useful for any of your readers who want to do more research – http://www.thecandidadiet.com/candida-resources/ It has lots of links to different medical and scientific studies that are focused on Candida.

My GI doctor told me. I’ve been telling Kaiser for a year I just didn’t feel well. Finally had an endoscopy (down to the stomach) and a biopsy of the esophagus made the diagnosis! I’m learning more and more from the internet. I seem WAY more educated on the topic than any one at Kaiser in the SF/Bay Area it seems. They put me on 10 days of Diflucan and said go to a gluten-free diet. I had already figured out that breads were closing up my throat.

I was tested through a naturopathic doctor names Dr. Finker (Finker Wellness). I am in California and was experiencing so many weird problems. I tried my regular MD for months, but all he wanted to do was put me on an anti depressant because all my labs came back normal. Dr. Finker is in Long Island, but I have had no problems with phone appointments. Did a stool test and discovered I had a pretty bad candida overgrowth and other things. Look her up.